Reply To: Very Sick Patient- Help wanted

  • Shelby Boone

    October 6, 2022 at 2:49 pm

    Also decreased UOP may be due to intrinsic kidney injury due to the Ambisome. Can switch to liposomal form if she’s not already on it

    Shelby Boone, MSN, APRN, CPNP-AC, CPN
    Director for PACU, Inpatient Heme/Onc, and BMT Advanced Practice Providers
    Texas Children’s Hospital
    Houston, TX
    Original Message:
    Sent: 10-06-2022 12:58 PM
    From: Kathryn Schiavone
    Subject: Very Sick Patient- Help wanted

    Hello all,

    I am a NP searching for a little bit of a discussion for my patient who currently is in the PICU with high fevers which will not subside.
    This is her 1st relapse ALL with CNS disease. She was receiving HD ARAC and was doing very well.
    2 weeks she trigged a “code sepsis” on our regular pediatric floor for fever and hypotension (which she has had many times before and totally been fine)
    She was transferred to the PICU and put on pressers, port was removed based on + fungal cultures 2 days later (Candida tropicalis).
    She since has had mental status changes, intubated, continued very high fevers, though ANC has recovered. EBM, CMV both negative,
    Currently on ambisome, and meropenem. Toci will be given today and thinking about VOD and administering Defibrotide.
    Urine output continues to decrease and BPs are worsening as well.


    Kathryn Schiavone, APN
    New Jersey
    United States